Barriers to Accessing Quality Health Coverage and their association with Medication Adherence in patients with Type 2 Diabetes Mellitus at a hospital in Peru

Background: Diabetes mellitus is a major challenge faced by health systems around the world, especially in low- and middle-income countries where, besides chronic non-communicable diseases, there is an overlap of infectious diseases. Aim: To determine the barriers to accessing health services associated with treatment adherence in patients with T2DM. Methodology: Analytical cross-sectional study. We conducted a structured survey to address sociodemographic and clinical aspects as well as access to health services and adherence to treatment according to the Tanahashi model and the Morisky-Green test. The survey was administered to 240 patients diagnosed with T2DM who attended the Daniel Alcides Carrion National Hospital in the region of Callao from January to June, 2019. The factors were determined through logistic regression, and odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: Sociodemographic, clinical and health care access factors were determined in the multivariate analysis with medication non-adherence: male gender (OR=9.89; CI95%: 5.70-18.95; p=0.000); schooling: without formal education (OR=14.50; IC95%: 5.88-17.56; p=0.001); obesity (OR=10.50; IC95%: 3.81-13.50; p=0.003); having a comorbidity (OR=3.80; IC95%: 2.57-4.37; p=0.001); not trusting health care staff (OR=8.51; IC95%: 5.2-12.50; p=0.002); considering that the prescribed treatment will not improve their health (OR=6.54; IC95%: 3.71-10.13; p=0.003); not having taken the medication because they lacked money to buy it at some point (OR=4.74; IC95%: 2.79-9.51; p=0.003), not having attended consultation due to lack of money for transport at some point (OR=4.71; CI95%: 3.60-9.52; p=0.003); considering that waiting time for health care is inadequate (OR=5.61; CI95%: 2.60-8.15; p=0.000): considering that health personnel are not trained to perform their health care (OR=3.76; CI95%: 1.51-4.80; p=0.001). Conclusion: Access to quality health services is a priority to control T2DM, which if left unattended, could become the greatest global health challenge in the future.